Increased fall risk in people with type 2 diabetes and cardiovascular disease: a systematic review and meta-analysis

People with type 2 diabetes (T2D) have an increased risk of falls, a concern further complicated by cardiovascular disease (CVD). Falls pose significant risks of morbidity and mortality, yet the interplay between T2D, CVD, and fall risk remains insufficiently understood. This study aimed to systematically assess the current evidence and estimate the risk of falls in people with coexisting T2D and CVD. A systematic literature search and a meta-analysis were conducted utilizing PubMed, Embase, and Cochrane using PRISMA guidelines. Studies assessing fall risk in people with T2D, with or without CVD, were included. Quality assessment was performed using validated tools such as JADAD, NOS, and GRADE. Existing literature indicates that people with T2D and coexisting CVD have a significantly higher risk of falls compared to those with T2D without CVD. This association was confirmed by the meta-analysis, which demonstrated a pooled odds ratio of 1.29 (95% CI 1.03-1.63). However, clear associations between specific cardiovascular outcomes-such as hypertension, orthostatic hypotension, heart failure, atrial fibrillation, and ischemic disease-and fall risk remained inconclusive. Some studies indicated that autonomic dysfunction, postural instability, and blood pressure dysregulation contributed to fall risk, but findings were inconsistent. The heterogeneity in study methodologies, outcome measures, and sample populations limits definitive conclusions. This review and meta-analysis found an increased fall risk in people with T2D and coexisting CVD; however, current evidence remains insufficient to establish a definitive causal relationship between CVD and fall risk, despite the observed higher fall prevalence.